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How to launch a peripatetic learning disability service

Services for clients with learning disabilities at Northamptonshire Healthcare NHS Trust have been completely remodelled and are now more successful than ever, writes Clare Lomas

When a shortage of funds forced the closure of two day centres for people with learning disabilities, the impact on their daily lives could have been devastating. But thanks to the hard work and determination of Carol Trill, services for clients with learning disabilities at Northamptonshire Healthcare NHS Trust have been completely turned around.

Winner of the first NT Award for Promoting Social Inclusion, sponsored by Unite, Ms Trill and her team turned the closure of the centres into an opportunity to set up a more user-sensitive, peripatetic service for people with learning disabilities.

‘The day centres were service-led rather than client-led and activities were developed by staff without individual preferences being taken into account,’ says Ms Trill.

‘We wanted to adopt a more person-centred approach – it is about individual wants and needs as opposed to managing large groups,’ she says.

Since the 2001 publication of Valuing People, the first government white paper on learning disabilities for thirty years, there has been a continued drive towards supporting people with learning disabilities to have more choice and control over their lives.

‘For so many years, people with learning disabilities have been institutionalised’

In 2006, the Healthcare Commission and the Commission for Social Care Inspection investigated the care of people with learning disabilities at Cornwall Partnership NHS Trust. The report that followed set out 28 key recommendations for improvement, including the need for person-centred planning in relation to activity and engagement.

‘For so many years, people with learning disabilities have been institutionalised,’ says Ms Trill. ‘But they have the same rights as everyone else. It is very important that they integrate and become citizens in their own right,’ she says.

Ms Trill and her team provide a service for 93 clients from Northamptonshire residential homes. For at least three half-days a week, a member of the peripatetic team visits each individual and uses a person-centred plan to help them choose and implement a curriculum of activities.

‘There is a broad spectrum of learning disabilities, but those with the most profound needs haven’t always had the same opportunities as others,’ says Ms Trill. ‘We work with service users, families and carers to come up with ideas and offer choices.’

As well as in-house activities, such as art, cooking and music and movement, health promotion work is undertaken, with the emphasis on exercise, healthy eating and living healthy lifestyles. Clients can also engage in activities that give them the opportunity to socialise and meet people from their local communities, such as going rambling, bowling or to dances.

‘One girl took a trampolining course and just couldn’t stop smiling’

‘It’s about finding an activity that you really enjoy,’ says Ms Trill. ‘We had one girl with very limited communication skills and it was difficult to find things she liked. ‘But when she took a trampolining course she just couldn’t stop smiling, she loved it. We took photos of her for her family, who were thrilled.’

When Ms Trill first suggested she wanted to take clients trampolining, and on sailing trips, she was met with some scepticism.

‘These types of activities had never been done before and people said it was impossible. Initially some were quite alarmed by the idea, but the response has been excellent. It is about training staff to come on board,’ she says.

Working with a physiotherapist, Ms Trill put together a manual handling document for the safe transfer of clients onto the trampoline, which was set into the floor. She also made user-friendly information packs to enable service users to make informed choices about the activities.

Promoting Social Inclusion is a new category for the NT Awards, focusing on areas where nurses have demonstrated real imagination and flair in developing services for hard-to-reach groups.

‘It involved an awful lot of hard work, but it really has been worth it’

The NT judges praised Ms Trill’s work as ‘a beautifully orchestrated project’ which they thought was ‘creative, innovative and responsive.’

After qualifying as a learning disabilities nurse in 2001, Ms Trill worked in the community and in day services.

In 2003, she became manager of the two large day centres she would have to close down just three years later. ‘We were informed in July 2006 about the proposed closures. Both staff and service users were very worried and there was some very negative media coverage,’ she says.

‘When I learned that the alternative was for the residential home staff to take on the role of providing activities for the centre’s users, I was very concerned. I didn’t feel this was viable as it was outside their training,’ she adds.

Ms Trill put together a proposal for the peripatetic service and two months after the centres closed in November 2006, the service was up and running. ‘It involved an awful lot of hard work, but it really has been worth it,’ she says.

Ms Trill says the success of the service is all down to team effort and they were all extremely pleased to win the NT Award. But she feels the real winners are the service users.

‘Looking at the service now, compared to how it was in the past, it is definitely more beneficial,’ she says. ‘Sometimes I still can’t believe we’re here.’

The response from service users to the new peripatetic team has also been extremely positive. As one service user says: ‘It’s better now than when I used to go to the day centre. It was boring there.

I like the person who works with me from the new team. She listens to what I want to do and helps me do things that are important to me, like visiting my family who live a long way away, visiting my mother’s grave, going out for lunch and shopping in the community. She helps me to learn new things as well.’

Overcoming challenges

Having overcome the major hurdles of submitting a proposal and securing funding, Ms Trill still faced some concerns from residential home staff.

‘We didn’t meet the barriers we could have come up against because we pre-empted a lot of problems,’ she says. ‘But some staff were apprehensive at first. Now they work in partnership with us and come up with some fantastic ideas.’

At present, Ms Trill heads a team of seven people, all of whom have extensive backgrounds in learning disabilities. Following the findings from a recent audit though, she hopes to be able to expand the team.

‘People were very happy with the service, but they all said they wanted more sessions which would require more staff,’ she says.

Ms Trill plans to reinvest the £1,000 prize money in the peripatetic service and extra funding for a new art centre has also just been confirmed. Due to open in March this year, service users will be able to use the centre to produce and then sell their own work.

‘Art is very therapeutic,’ says Ms Trill. ‘The studio is for everyone and working alongside other artists will help increase self-esteem and could lead to possible employment.’

Angela Roberts, joint service development manager for children’s services at Wrexham Local Health Board, who was one of the judges for the award, says she was particularly impressed by the ability of Ms Trill and her team to take on a challenge.

‘They took a desperately negative situation and turned it into a positive one for people with learning disabilities,’ she said.

‘Not only did they turn the service around, they made it better than it was before with less funding, which I think is extraordinary.’

KEY PRINCIPLES OF A PERIPATETIC SERVICE FOR PEOPLE WITH LEARNING DISABILITIES

• Adopt an individualised approach – draw up a person-centred activity plan to ensure that all activities are tailored towards a client’s specific needs

• Promote the rights, independence, choice and inclusion of people with learning disabilities as set out in the government paper Valuing People

• Look at the person as a whole and not just the condition. People with learning disabilities have both physical and emotional needs

• Collaborate with service users, carers, family members and key stakeholders when deciding on care options and activities for clients

• Have a transformational leadership approach – managing change effectively comes from having a vision for the future and goals to aim for.

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